“Do not call me a migraine sufferer. I have an illness called migraine, but I do not suffer from it. Having migraine is not a choice, suffering from it is. Suffering is an emotional reaction, a decision someone makes to allow the difficulties in their life to cause mental torment. I cannot avoid the physical and emotional pain of migraine, but I can choose how to react to it.”

Some readers said that the post was belittling or shaming people who don’t think the same way I do. That was absolutely not my intent, but it got me wondering if I would have reacted with anger if I’d come across the same post. Then I remembered the time, 10 years ago almost exactly, when I saw an article from Oprah’s magazine called Living With Pain being praised on a migraine forum.

Reading it enraged me.

I was in the most desperate place I’d been to that point (though I’ve been far more desperate since then) and the ways the author described coping with chronic migraine, tension-type headache and cluster headache seemed like total bull. I’m pretty sure I thought that her pain couldn’t possibly be as severe as mine, that no one could possibly have that attitude with the sort of pain I endured.

Today I am laughing at all the similarities between my attitude and the one the writer of the Oprah article describes. I’m not sure where or when or how I picked it up, but I’m unbelievably grateful that I did.

It is this attitude that I believe has kept me going, even when I couldn’t fathom how I’d get through another day. It is why I finally had a migraine-free day after at least 12 years of daily attacks. It is what compelled me to investigate an essentially unheard of migraine treatment to discover one that actually helps me. It is why I’m so happy to have days with only head pain and why level 4 migraines aren’t a big deal (well, that and the perspective that comes with having been housebound and bedridden from migraine).

If I want to find the joy in life, if I want to continue to reduce the frequency and severity of my migraines, I cannot think of myself as a sufferer. This is not because migraine (or any headache disorder) is trivial or insignificant, nor does it mean I am without grief and anger about what it has done to my life. For me, thinking of myself as a sufferer is a short step away from believing there is nothing worth living for. There are plenty of ways debilitating chronic migraine pushes that belief all on its own, I don’t need to add any more fuel to the fire.

This is what works for me personally. Going by the number of likes and shares my post got, I am not alone. Still, this way of thinking doesn’t work for everyone. I understand why; I’ve been there myself.

People say that you don’t notice how many pregnant women are in the world until you’re pregnant yourself. I’m finding a similar phenomenon now that I’m depressed again — I barely thought about depression for a couple years, but now that it’s back on my mind, I’m noticing articles everywhere. Three very different, very interesting articles on depression have caught my eye this week.

Why Don’t Antidepressants Work Faster? (Slate)
I’m pretty sure anyone who has taken antidepressants has wondered this very thing. This informative article from a Scientific American writer is easy to understand, but doesn’t skip over important scientific information.

Sleep Therapy Seen as an Aid for Depression (New York Times)
A newly published study found that helping depressed people overcome insomnia with a “cheap, relatively brief and usually effective” form of therapy could double their chances of a full recovery. The technique uses specialized cognitive-behavioral therapy and sounds kind of like typical sleep hygiene recommendations, but is actually quite different, according to researchers.

Standing up for myself and having difficult conversations is something I haven’t done much of in, oh, 15 years. Doing these things has always been an effort for me, but I managed to do it fairly effectively before migraine overwhelmed me. Since then, all of my energy and emotional wherewithal have gone toward managing migraine. Added to those obstacles is the fact that migraine compromises my ability to think and find the words to express my needs. Simply put, I’ve been too exhausted and brain-fogged for the work of of conflict and difficult conversations.

It’s a big problem. It has reached nearly every area of my life, from store clerks and customer service reps, to coworkers, to friends and family. I’ve berated myself for being a doormat and felt like my place in the world had shrunk to almost nothing. Disappointments and frustrations mount and I feel like I have no voice. It’s not an emotionally healthy way to live, but my physical health has left little room for emotional self-care. I’ve been reconnecting to my emotional self and relearning those self-care skills since April, which has been hard, rewarding work.

I got to put that work into action yesterday by standing up for myself to the massage therapist I’m seeing for craniosacral therapy. My first sessions with her were great, but in the last two, she started some emotional therapy-type work and visualizations that were not OK. She meant well, but her technique left me feeling emotionally violated and unsafe. Instead of canceling my remaining appointments and never seeing her again, which was my instinct, I called her and established new “ground rules.” Confronting her was as much about the need to assert myself as it was about wanting to continue craniosacral therapy with her.

It’s only one step and was a relatively easy one, since I was pretty sure she would be receptive. Still, it’s one more step toward feeling like I’m a whole person who occupies a valuable place in the universe, not a migraine zombie.

I resisted going off the supplement that was causing depression-like symptoms, then I resisted starting antidepressants when I realized the depression hadn’t lifted. I told myself I didn’t want the side effects of antidepressants or to complicate my migraine variables. Those excuses are partly true, but mostly I didn’t want to acknowledge that I’m depressed enough to require medication.

The day I started back on Wellbutrin, my mood lifted. The antidepressant medication didn’t change my mood in a single day; the decision to take care of myself did. I don’t want to be depressed, but wishing it away is a fruitless endeavor. Instead of continuing to hide from the truth, I both recognized and accepted the depression and chose to treat it in the only way that’s ever been effective for me.

I am not out of the woods. It will take weeks to ramp up to a full dose of Wellbutrin and could take even longer to know how well it’s working for me. If it doesn’t, I could spend months trying to find the right medication (or medications) and dose. As I’m figuring all that out, I can take comfort in my decision to start taking antidepressants.

Self-care often falls by the wayside when a person is depressed. It doesn’t help that depression saps one’s motivation and hope. Overcoming all these factors makes for a gigantic first step. I’m proud of myself for taking it.

Maybe the 5-MTHF was the depression trigger, but it was presumptuous to conclude the supplement was the only factor for my depression. I felt great for a few days after discontinuing 5-MTHF, then the depression returned, building each day until I awoke at 4 a.m. Monday morning to suicidal ideation. Don’t worry, suicide is not on my agenda and I’m fully aware these are not my own thoughts, but are fueled by depression. I’m not going anywhere, but it’s still terrifying to have these thoughts pop into my head.

So, after slowly tapering off antidepressants over three years, I’m back to them. I haven’t started any yet, but I’ve requested a Wellbutrin prescription from my therapist/naturopath (fortunately, naturopaths have full prescribing rights in Arizona). I chose Wellbutrin because it has fewer sexual side effects than other antidepressants, it has been effective for me in the past, and it’s relatively easy to taper off when I’m ready to stop taking it.

Even yesterday I was resistant to starting another antidepressant. It’s not that I’m against medication, but I don’t look forward to adding any more side effects to my life and I’m already juggling so many migraine-related variables that I’m reluctant to add one more factor to the mix. Still, the constant teariness and feelings of hopelessness, not to mention suicidal ideation (which hasn’t happened since Monday morning), aren’t doing me any favors.

I’m a little quieter than usual and now you know why. Contrary to my typical depression pattern, I’m still writing a lot of drafts, though getting them to a publishable state is beyond my current ability. I’m sad and frustrated and in a mental fog, but I’ll be OK. I’ve been through much worse depression before and feel fortunate to have caught this one fairly early. I’m also grateful to have an excellent therapist to help me this time around. Please don’t worry about me, though I always welcome your good thoughts, positive energy, prayers, or whatever it is you offer to others in times of need. I really will be OK, I just need some time — and some drugs — to get there.